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NHS England warns some urgent cancer referrals will need to be downgraded

Urgent cancer referrals from GPs may need to be downgraded or avoided when hospital ‘capacity is particularly constrained’ during the coronavirus (Covid-19) emergency, NHS England has said.

The new interim guidance regarding two-week-wait referrals, issued last week, modifies existing cancer waiting times guidance ‘until further notice’.

NHS England stressed that the ‘policy remains that providers receiving referrals may not downgrade urgent cancer referrals without the consent of the referring primary care professional’ but said GPs and hospitals should work together to prioritise cancer referrals in particularly busy times.

‘Where capacity is particularly constrained providers should ensure processes are in place to prioritise particularly urgent referrals, including greater communication between primary and secondary care to downgrade or avoid referrals where possible,’ the guidance said.

It added: ‘Where referrals are downgraded or avoided outside the usual policies and NICE guidance, providers should seek to ensure appropriate safety-netting so that if patients deteriorate or their risk of a cancer diagnosis increases, they can be appropriately referred for further investigation.’

The new guidance also advises that cancer investigations ‘minimise interactions and appointments with health services’.

To that effect, ‘on receipt of a [two-week-wait] referral, providers should ensure that as far as possible telephone triage is available to stream patients directly to a test where appropriate’; and a ‘telephone appointment with an appropriate specialist clinician’ is ‘accepted as “first appointment” for the purposes of recording cancer waiting times data until further notice’.

‘It is important that during the response to the Covid-19 pandemic, appropriate clinical priority is given in the diagnosis and treatment of cancer, and we understand that service provision may need to flex as part of infection control,’ NHS England said.

The news comes as a London hospital trust has announced that it is stopping all cancer outpatient appointments, including chemotherapy, in response to the coronavirus pandemic.

The Barking, Havering and Redbridge University Hospitals NHS Trust said the the aim of the ‘significant changes’ was ‘to keep our patients safe as we deal with Covid-19’.

It said in a statement: ‘This is because we are now seeing an increase in the number of seriously ill patients (who have tested positive for Covid-19) at our hospitals, which is only going to increase in the days and weeks ahead.

‘Postponing chemotherapy will help to protect our cancer patients as these intense drugs affect their immune system, making them more susceptible to contracting Covid-19. We are reviewing these patients to ensure no harm will come to them by delaying their treatment.’

Oncologist Professor Karol Sikora told Pulse: ‘Cancer patients are dealing with both the coronavirus crisis and the ordeal of having cancer. It is a frightening time for them and we should all be working to ensure treatment is only delayed when it won’t have any adverse impact on the patient.

‘If the risk of continuing is significant compared to the likely benefit, then it’s better to stop. This is a highly individualised decision.’

The news comes as NHS England yesterday asked GPs to review cancer patients which may need enhanced advice on shielding themselves against the coronavirus.


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